Korean J Radiol.  2014 Feb;15(1):80-86. 10.3348/kjr.2014.15.1.80.

CT-Guided Sclerotherapy for Simple Renal Cysts: Value of Ethanol Concentration Monitoring

• Yu JH
• Du Y
• Li Y
• Yang HF
• Xu XX
• Zheng HJ

• KMID: 1711481
• DOI: http://doi.org/10.3348/kjr.2014.15.1.80

Abstract

OBJECTIVE
The aim of our study was to evaluate the differences between sclerotherapy with and without ethanol concentration monitoring for the treatment of simple renal cysts.
MATERIALS AND METHODS
Sixty-seven patients with 70 simple renal cysts were randomly assigned to two groups in a 12-month prospective controlled trial. One group (group A) was treated with computed tomography (CT)-guided sclerotherapy without ethanol concentration monitoring (33 patients with 35 cysts), whereas the other group (group B) had ethanol concentration monitoring (34 patients with 35 cysts) during the procedure. Treatment outcomes between the two groups were compared 12 months later with follow-up ultrasound examination.
RESULTS
After the 12-month follow-up period, the overall success rate was 74.3% in group A and 94.3% in group B (p = 0.022). The mean cyst size before and after treatment was 8.6 +/- 2.0 cm and 2.3 +/- 2.9 cm, respectively, in group A, and 8.4 +/- 1.7 cm and 0.8 +/- 1.9 cm, respectively, in group B. The final size of the cysts in group B was significantly smaller than that in group A (p = 0.015). The likelihood of treatment with ethanol concentration monitoring being successful was approximately 16 times higher than without ethanol concentration monitoring (p = 0.026; odds ratio = 15.7; 95% confidence interval: 1.38-179.49). There were no major complications in either group.
CONCLUSION
Monitoring of Hounsfield units (HU) of ethanol by CT is an effective method in the treatment of simple renal cysts with ethanol sclerotherapy. The ethanol sclerotherapy procedure can be terminated at the point of clear fluid aspiration because the HU (-190) of CT scan corresponds to it.

Keyword

Simple renal cyst; Ethanol-Sclerotherapy; Computed tomography; Interventional radiology

MeSH Terms

Adult
Aged
Aged, 80 and over
Cysts/radiography/*therapy
Drug Monitoring
Ethanol/*administration & dosage/analysis
Female
Humans
Kidney Diseases, Cystic/radiography/*therapy
Male
Middle Aged
Prospective Studies
Radiography, Interventional/methods
Sclerosing Solutions/*administration & dosage/analysis
Sclerotherapy/*methods
Tomography, X-Ray Computed/methods
Treatment Outcome
Young Adult
Ethanol
Sclerosing Solutions

Figure

• 

  Fig. 1 69-year-old woman with persistent flank pain for 6 months. (A) Simple renal cyst before sclerotherapy; (B) diluted contrast medium (15% of aspirated volume) was injected into cyst to ensure that there was no communication of cyst with collecting system or leakage into peritoneal cavity; and (C) contrast medium was replaced with 99.9% ethanol in amount corresponding to 25% of volume of aspirated fluid. After case underwent repeated aspirations and injections, with 20 mL in each injection, for five times, Hounsfield value of cyst fluid reached -201 HU; and (D) ethanol injected was withdrawn. HU = Hounsfield units

• 

  Fig. 2 Consolidated Standards of Reporting Trials flow diagram.

• 

  Fig. 3 Cyst size before and after treatment in group A. Mean cyst size before and after treatment was 8.6 ± 2.0 cm and 2.3 ± 2.9 cm (p < 0.001).

• 

  Fig. 4 Cyst size before and after treatment in group B. Mean cyst size before and after treatment was 8.4 ± 1.7 cm and 0.8 ± 1.9 cm (p < 0.001).

Reference

1. Hanna RM, Dahniya MH. Aspiration and sclerotherapy of symptomatic simple renal cysts: value of two injections of a sclerosing agent. AJR Am J Roentgenol. 1996; 167:781–783.

2. Okeke AA, Mitchelmore AE, Keeley FX, Timoney AG. A comparison of aspiration and sclerotherapy with laparoscopic de-roofing in the management of symptomatic simple renal cysts. BJU Int. 2003; 92:610–613.

3. Sandler CM, Houston GK, Hall JT, Morettin LB. Guided cyst puncture and aspiration. Radiol Clin North Am. 1986; 24:527–537.

4. Agarwal M, Agrawal MS, Mittal R, Sachan V. A randomized study of aspiration and sclerotherapy versus laparoscopic deroofing in management of symptomatic simple renal cysts. J Endourol. 2012; 26:561–565.

5. Xu XX, Du Y, Yang HF, Zhang Q, Li Y, Zee CS. CT-guided sclerotherapy with ethanol concentration monitoring for treatment of renal cysts. AJR Am J Roentgenol. 2011; 196:W78–W82.

6. Akinci D, Akhan O, Ozmen M, Gumus B, Ozkan O, Karcaaltincaba M, et al. Long-term results of single-session percutaneous drainage and ethanol scleroth erapy in simple renal cysts. Eur J Radiol. 2005; 54:298–302.

7. Cho DS, Ahn HS, Kim SI, Kim YS, Kim SJ, Jeon GS. Sclerotherapy of renal cysts using acetic acid: a comparison with ethanol sclerotherapy. Br J Radiol. 2008; 81:946–949.

8. Ham WS, Lee JH, Kim WT, Yu HS, Choi Y. Comparison of multiple session 99% ethanol and single session OK-432 sclerotherapy for the treatment of simple renal cysts. J Urol. 2008; 180:2552–2556.

9. Yamamoto K, Sakaguchi H, Anai H, Tanaka T, Morimoto K, Kichikawa K, et al. Sclerotherapy for simple cysts with use of ethanolamine oleate: preliminary experience. Cardiovasc Intervent Radiol. 2005; 28:751–755.

10. Demir E, Alan C, Kilciler M, Bedir S. Comparison of ethanol and sodium tetradecyl sulfate in the sclerotherapy of renal cyst. J Endourol. 2007; 21:903–905.

11. Egilmez H, Gok V, Oztoprak I, Atalar M, Cetin A, Arslan M, et al. Comparison of CT-guided sclerotherapy with using 95% ethanol and 20% hypertonic saline for managing simple renal cyst. Korean J Radiol. 2007; 8:512–519.

12. Bosniak MA. The current radiological approach to renal cysts. Radiology. 1986; 158:1–10.

13. Zerem E, Imamovíc G, Omerovíc S. Symptomatic simple renal cyst: comparison of continuous negative-pressure catheter drainage and single-session alcohol sclerotherapy. AJR Am J Roentgenol. 2008; 190:1193–1197.

14. Stevenson JJ, Sherwood T. Conservative management of renal masses. Br J Urol. 1971; 43:646–647.

15. Lin YH, Pan HB, Liang HL, Chung HM, Chen CY, Huang JS, et al. Single-session alcohol-retention sclerotherapy for simple renal cysts: comparison of 2- and 4-hr retention techniques. AJR Am J Roentgenol. 2005; 185:860–866.

16. Chung BH, Kim JH, Hong CH, Yang SC, Lee MS. Comparison of single and multiple sessions of percutaneous sclerotherapy for simple renal cyst. BJU Int. 2000; 85:626–627.